UW research aims to keep seniors fit and active
Nellie Frye needed groceries. So she called her friend Mildred, and the two set off, on foot, to the supermarket.
“The last time I walked up that hill I swore I’d never do it again—it nearly killed me,” claimed Nellie, age 94, a slight smile working the weathered corners of her mouth. “But this time we made it back all right.”
Months earlier, Nellie’s major activity was sitting in her easy chair. “It wasn’t good. My daughter kept telling me to get out and my doctor gave me exercises but I didn’t do them,” she admits.
Her motivation to get moving came unexpectedly—the offering of a free exercise program for senior women living in her low-income housing building. Led by Marie Elaine Cress, UW exercise physiologist, the program is a research study designed to help seniors gain energy, motivation, strength and endurance through daily exercise.
Curiosity outweighing her skepticism, Nellie enlisted. And for the past month her week’s activities have included walks and classes in strength training and flexibility.
Thousands of Seattle-area residents are reaping benefits from research projects and partnerships with senior centers, housing authority buildings and health-care management.
Today, clad in a pink sweat suit, cuff-like weights hanging from her ankles, Nellie joins her fellow neighbors/fitness partners in the community room for strengthening exercises.
“It’s time for your hip flexors,” calls Cress brightly, exchanging smiles with the half-dozen women as she raises her leg up and down. “These are the ones that help you make it up the stairs.”
With slow determination, the rest of the group follows Cress’ lead—steadying their balance by clutching onto school chairs and exchanging encouragement, giggles and grunts. Like Nellie, other participants have been pleasantly surprised with the program, noting they “don’t wobble as much,” “have more energy” and “feel like a new person.”
This newfound zest for life is spreading. Thousands of Seattle-area residents are reaping benefits from research projects and partnerships with senior centers, housing authority buildings and health-care management. At the center of this movement is the University of Washington Northwest Prevention Effectiveness Center, a collaborative center guided by the mission of “keeping older adults healthy and independent.”
“Throughout the years our primary goal has remained the same: preventing dependence and institutionalization,” stresses Ed Wagner, director of the prevention research center and the Center for Health Studies at Group Health Cooperative in Seattle. “These are the things seniors fear more than death.”
It only takes a quick look at America’s projected demographics to see the wrinkles. In 1900, one in every 25 Americans was over 65. By 2050, it’s estimated that one in five Americans will be over age 65. And those aged 85 and older are the most rapidly expanding elderly group, according to figures from the U.S. Census Bureau.
The effects of this population transformation pose challenges for all of society. Perhaps the most significant is the price to be paid, both in human and economic costs, for a poor quality of life resulting from illness that could have been prevented.
Keeping our aging population healthy and independent is a national priority. Yet this task is daunting. Results from the U.S. Surgeon General’s 1996 Physical Activity and Health Report show some startling statistics:
* Less than 20 percent of Americans meet physical activity guidelines.
* By age 75, one in two women and one in three men engage in no physical activity.
How can such monumental health problems be addressed? By harnessing the power of prevention. While medical research offers ways to mend a damaged heart valve or fight an infection, prevention research focuses on keeping people free from disease and helping them lead healthier lives.
“The three leading causes of death—heart disease, cancer and stroke—are linked to modifiable risk factors: tobacco, poor diet/lack of exercise and alcohol,” points out David Buchner, deputy director of the Northwest Prevention Effectiveness Center. “It’s by changing these behaviors that we can make a real difference.”
Lloyd Quaschnick pumps some iron during a weightlifting class for seniors at the Schwabacher House in Ballard. Photo by Jayne Paprowicz.
History shows that prevention does work. “Screening and treatment for eye disease among people with diabetes saves the federal government at least $248 million a year,” reports the U.S. Centers for Disease Control. “For every $1 spent on school-based drug and alcohol, tobacco and sexuality education, $14 are saved in avoided health care costs.”
One of the appealing aspects of preventive medicine for the elderly is its cost. The use of low-tech methods—hand weights, water exercises, nutrition guidelines, community meetings—illustrates the effectiveness of simplicity.
The UW center is a pioneer of prevention research and is the only federally funded center devoted to promoting health in men and women aged 65 and over. Established by the Centers for Disease Control in 1986, it is a collaborative program of the UW School of Public Health and Community Medicine and Group Health Cooperative of Puget Sound.
Throughout the years, the center has developed and tested inexpensive, practical ways for older adults to improve their health, well-being and physical function. And it has done so in a somewhat unconventional way—going out into the community, including senior centers and low-income housing, to reach seniors in need of support.
Lois Shaw found help last year. Shortly after suffering a stroke, the 83-year-old started exercise classes in her subsidized housing unit.
“I’ve come a long, long way,” Lois bubbles, her voice a mix of pride and glee. “I went from using a walker to a cane, and I don’t even need the cane when I’m at home.”
The regular exercises have also helped Lois continue her own cooking and housework. And she receives regular comments from friends and neighbors about her progress.
“It’s really got me on my feet again,” she professes.
Success stories like Lois’ make preventive medicine appear quite simple. And while the messages may indeed be basic ones—exercise more, feel better—instilling them into people’s daily lives requires a combination of many crucial elements. These include: developing successful programs, working with community partners, motivating individuals to cultivate their health, enhancing individual support networks and creating projects with staying power.
Should seniors lift weights? Back in 1993, neither center researchers nor residents at the Northshore Senior Center knew the answer to this question. And so began one of the center’s first studies, the Wellness Intervention Study for Elders, which tested and implemented a method to prevent disability from falls.
Six months later, after participating in one-hour fitness sessions three times a week, the group of 50 seniors reported some pleasant surprises. From increased balance and movement—being able to bend over and tie shoes, walk up stairs and work in the garden—to general health improvements—decreases in blood pressure, lessening of heart palpitations, increased energy and stamina.
In further analysis, researchers found participants had overall improvements in walking distance and knee strength, significant decreases in depressive symptoms and a 25 percent reduction in restricted activity days.
“This study helped us see the possibilities of what a basic, structured program could do at the community level,” Buchner explains. “Providing inexpensive ways to promote lifestyle change and tapping the resources of an existing infrastructure are the elements needed for real success.”
Lorraine Fernandez raises her arms during an aquatherapy class at the Yakima YMCA. The class is part of a UW research project comparing exercise with medication for the treatment of osteoarthritis in seniors . Photo by Kirk Hirota, Copyright 1997 Yakima Herald Republic.
Findings of the center’s initial studies helped provide the foundation for the many projects to follow. Rather than going it alone, researchers teamed with community partners to extend the reach and success of their efforts.
Ruth Herr didn’t know where to turn after being diagnosed with osteoporosis three years ago. Active all her life—ice skating since she was 8, walking three miles daily—the 80-year-old woman wasn’t ready to slow down, but she knew she would need help to keep her body moving.
“I was desperate to find something or someone that could help me fight this,” she relates.
After more than a year of searching, Herr found what she was looking for at a local senior center—one of the exercise studies offered through the UW program. She enrolled and two years later still participates in exercise classes each week.
“This program has been a lifesaver for me,” she says. “I feel better, I’ve made some great friendships and I’ve had wonderful support from people who care.”
Reaching out to seniors like Herr is only possible through cooperation. “We can’t do it alone,” is a chorus repeated again and again by center researchers, who have all come to value the knowledge and expertise that each partner offers.
“This has been a perfect match,” agrees Matthew Doherty, manager of senior and disability services at King County Housing Authority.
Doherty notes that programs like Cress’ let his residents exercise even though they may not have the means to pay for recreation or the ability to visit senior centers. Proven results from these studies have helped community partners secure funding to keep the programs alive after research has ended.
“These partnerships become more and more critical,” Buchner stresses. “Linking with community resources, health care providers and individuals provides the strength we need.”
Encouraging words, a fitness partner or a regular exercise schedule can mean the difference between action and inaction for many seniors.
Getting out of the house can be difficult some days for Hal and Elizabeth Keene, who both suffer from osteoarthritis. Yet there’s one excursion the pair won’t miss—a drive to the Shoreline Community Swimming Pool for water aerobics.
“This program forces us to get out and exercise—something we never would have done without it,” explains Elizabeth, her husband nodding in agreement.
For the past six months, three days a week, the couple have participated in the low-impact program developed by the National Arthritis Foundation. A research study through the UW center is testing the effectiveness of this program as a low-cost means for preventive care. Participants in cities throughout the state are contributing to the project.
In the warm, shallow waters of the Shoreline pool, energetic instructor Lisa Wilson leads the Keenes and six other seniors through underwater leg lifts, bounces and arm strokes at a near-continuous pace.
“Higher, higher, there you go!” she calls with success as the legs of two participants finally crest the water. “Let’s do three more!”
The Keenes are impressed with the results, which they say began to appear after the first week’s class. So impressed, in fact, that they wrote to Hal’s sister in Kennewick to urge she get involved.
“She called to sign up right away,” Hal says. “It will be good for her.”
“It’s hard when you find yourself feeling like you’re 100 years old,” Hal relates. “It’s the little things, things like getting in and out of a car, that you realize are important to be able to do.”
Perhaps the toughest challenge of preventive research is ensuring its lasting success. In addition to building muscle, building relationships has surfaced as a primary motivator in keeping seniors active.
Hazel Bower, 82, still drives to the community swimming pool for senior swim hour whenever she can. But now, after meeting other residents through an exercise class in her housing unit, she seldom drives alone.
“There’s an invitation to anyone who would like to come with me,” she explains. “It’s such a nice swimming facility, and many people don’t have transportation to get there.”
Lois Shaw, who was so inspired with her renewed vim and vigor, banded together with fellow exercise partners to encourage other less-mobile residents in their subsidized housing unit.
Posted throughout the hallways of Pleasant Valley Plaza are the team’s self-made promotional posters. “Why not do both? Watch TV and exercise,” one placard proclaims, featuring a color photo of Lois performing leg stretches in her easy chair. “We hope this helps other people see how wonderful and how important exercise is,” Lois explains.
A unanimous feeling among center researchers and partners is that programs and connections established through research should not be severed. To that end, many of the seeds of prevention research the center has planted continue to grow and spread.
Using the center’s first wellness study as a model, Senior Services of Seattle/King County and Group Health Cooperative have received funding to implement a fitness program at 16 area senior centers.
Center research continues to evaluate the influences of social networks, healthy eating and physical activity among elderly residents of public housing units. Other special projects include promoting the health of persons with disabilities, measuring the effects of physical activity counseling in a managed care setting, and providing health promotion/disease prevention training to workers in public health agencies.
Expanding the reach and the partnership of prevention-based programs remains an ongoing goal. Of particular interest is developing links through public health agencies and health maintenance organizations. Having HMOs endorse the idea of preventive care for older people and contribute resources to public agencies help make these programs available to all seniors.
“There’s no question the older population is getting healthier,” says Wagner. “The important issue for the future is to get the health-care world to become strong supporters of this and recognize the advantages of this for their systems and health care dollars.”
Even with more than a decade’s worth of experience under their belt, center researchers and partners know there is still much more to accomplish.
Yet the success of the programs has already helped to change the daily lives of Americans. Hal Keene, and others who have seen directly the potential for preventive health care, are hopeful that soon all Americans will reap benefits.
“You start to realize how this could be a godsend for so many people,” Keene relates. “We hope that others benefit from this too, just us we have.”
Staying active: Tips for the elderly
There are many ways to build more activity into your daily life and improve your health. Here are some suggestions you may want to consider:
- Take the stairs instead of the elevator or escalator.
- Walk to a neighbor’s house to chat instead of using the phone.
- Organize your housework so you can use more energy.
- Get off the bus a block early and walk home.
- Mow your lawn.
- Sweep your walks and patio.
- Park at the far end of the parking lot.
- Walk to the store.
- Take your dog for a walk or offer to walk a friend’s dog.
- Enroll in a dance class.
- Move around your house as you open your mail or watch television instead of sitting in your easy chair.
Source: UW Northwest Prevention Effectiveness Center